Quote:
Originally Posted by dragonfly2
First, let me comment on the above quote. I also believe that the blood levels of vitamins should be taken before supplementing. One new area in depression research is the use of Vitamin D, which most people are low in (I'm a Medical Technologist and have seen hundreds of Vit D level results come across my desk). My levels are low and my pdoc has me on 4000 IU/d.
The other thing I want to mention is that they have found benefits of a form of folic acid called L-methylfolate in depression. A patient's folate level can be within the normal range, yet the availability of the folate to the body may not be optimal. This can be detected by looking at homocysteine levels, which would be elevated in a bioactive folate deficiency. There is a "medical food" (not a drug per the FDA) called Deplin that they are using to augment antidepressants in people with low levels of bioactive folate.
Here's a link to information on the benefits of L-methylfolate in depression:
http://www.cnsspectrums.com/aspx/art...articleid=1267
The other thing I wanted to bring up is that it sounds like your doctor's concern isn't with the bipolar, but the OCD. There are very successful doctors out there with bipolar disorder and it sounds like yours is not severe. My concern for you and the bipolar would be during internship and residency when you're working 36 hour shifts and not sleeping. I'm not sure what year of med school you are in, but you may have time to address the OCD to a point where it won't interfere with the pace you will need to keep up. Also, I'm not sure if you've chosen a specialty yet, but some areas with less patient contact (radiology, pathology, research) require going through things with a finer-toothed comb than others. Just some things to consider.
But, no, I wouldn't allow this guy to sway your commitment to your chosen career. |
Thank you, I will research the L-methylfolate. It's always great to hear about new avenues of research. I'm one of those people who will obsessively look up stuff on pubmed (hah, can you tell?)
I had actually asked my p-doc about taking folic acid supplements because I had read that depakote depletes folate, so many people who are on depakote take folic acid supplements. He adamantly told me not to take (standard) folic acid, because my folic acid levels were normal (right in the middle of the normal range), and he mentioned the link with colorectal cancer as a reason not to take them unless absolutely necessary. He told me I should only take folic acid if I'm trying to get pregnant or if I become deficient in folate in the future (he said he would keep testing me).
I really like my new p-doc because the first thing he did when I came to see him was order a FULL panel of blood work (and I mean FULL...pretty much the only box he didn't tick was hepatitis serology!) He did a CBC, LFTs, fasting glucose *and* HbA1C, lipid profile, BUN/Cr, TSH *and* T3/T4, prolactin, FSH/LH, testosterone, ferritin, vitamin D...the whole gamut. Just to establish a base line and rule out any underyling physiologic causes. And he happened to disocover both my ferritin and vitamin D deficiency and my ****** lipid profile (at the tender age of 23 and normal BMI to boot...damn genetics!)
And next week....I'm having an EEG, just to rule out anything freaky happening there. How awesome is this doctor? I think every psychiatric patient should go through this whole gamut of tests at least once just to rule out any underyling physical illness that could be contributing to their symptoms.
My last p-doc never wrote me a single blood test in the 10 years that she treated me. Never!
ANYWAY.
As to your question. I'm in my second year. My clinical rotations (clerkship) start next year. That's why my p-doc is really pushing me to take academic leave next year and do a master's. He doesn't think I'm ready for clinical rotations, and wants me completely stabilized and at the top of my game before I start my third year of med school. Doing a (course-based) master's will give me some structure and something to do (and something to put on my resume) while I keep tinkering with my meds and fully recover and prepare for the stress of clinical rotations. And I think you are right that he was more concerned about the obsessiveness than about my moods. He kept saying that I'll only have a few minutes with each patient, and I won't have time to obsess. That I'll have to move on. The thing is, I think I actually do better in such an environment, because it FORCES me to move on, and doesn't allow me to keep ruminating and obsessing over one thing. Rather than giving my OCD what it wants (a bunch of slides and a microscope), I should give myself a structure that doesn't allow me to indulge my OCD. Something that forces me to live in the moment, and behave like a normal human being. Does that make sense?
As for sub-speciality choices, I would be devastated if I were to become a pathologist or radiologist. I definitely want a specialty with tons of patient care. I'm thinking internal medicine at this point. I know I'm good at connecting with patients -- I've volunteered with patients for years before med school. I think I am my best self when I am taking care of other people. It takes me out of my obsessive, ruminating mind and focusses me outward in way that I can make a tangible difference in someone's life. I do think that I would be better suited to a sub-specialty where I can spend a long time meeting with each individual patient. I would be terrible at something fast-pased like the ER or walk-in clinic, but good at something more leisurely like psychiatry or internal medicine with long appointment times. Something where I could really sit down and talk at length with my patient, and give him or her my undivided, unhurried attention for a good 30-minute block of time. Working in a teaching hospital would also be a good idea, because the pace is a lot more relaxed (as you are teaching residents, and everything takes 3x as long because you have to demonstrate and explain what you are doing).
As for research....I LOVE it, but it feeds my mania and obsessions, obviously. I don't think it's good for my mental health to get too involved in research.
Anyway, thank you. You have given me a lot to think about. And maybe I shouldn't have stayed up last night because I am maybe typing too much, hah.